Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review

Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery

Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.

Persistent eschar-like wound healing after Q-switched 1064 nm hybrid nanosecond-picosecond laser monochromatic tattoo removal: management and evolution

Q-switched (QS) Nd: YAG lasers are frequently utilised light sources for tattoo removal due to their precise micro-confined photo-acoustic interaction with exogenous and endogenous pigments. In order to achieve optimal results, several treatment sessions are usually required. However, the number of sessions depend on tattoo size, design complexity, pigment quantity within dermal layers, and anatomical location. Higher energy settings have often been used to reduce treatment sessions to a minimum however, this approach may lead to possible post-laser skin complications such as pathological wound healing. This case report highlights the importance of recognizing early stages of pathological wound healing encountered after high fluence 1064 nm QS laser tattoo removal. Early implementation of a proportional wound care strategy with anti-neoangiogenic and anti-inflammatory properties through the unconventional use of potent topical steroids applied in a pulsed fashion resulted in positive control of the tissue repair processes. This approach led to effective wound healing re-modulation achieving near normal skin remodelling and optimal tissue healing which in turn, permitted the completion of necessary QS tattoo removal sessions to accomplish successful and safe tattoo fading whilst maintaining overall patient satisfaction.

Assessing the efficacy of a 100 ps Nd:YAG laser for tattoo removal in a minipig model

Using a minipig model, we evaluated the efficacy of the 100 ps Nd:YAG laser in the removal of tattoo pigments, specifically blue, green, red, and yellow. We observed distinct pigment responses to 532/1064 nm wavelengths at various energy settings. Through a combination of clinical, spectroscopic, and histological methods, we found the 532 nm wavelength to be most effective in disrupting all colors, with notable results for green and yellow at 0.4 J/cm2 and red at 0.72 J/cm2. The 1064 nm wavelength reduced pigment in yellow (1.51 J/cm2), green (1.35 J/cm2), and blue (1.11 J/cm2) tattoos, but was surpassed by the 532 nm in efficiency. Our data underscores the crucial interplay between pigment traits and laser settings in tattoo removal. We advocate for tailored treatment strategies, integrating pigment hue and laser wavelength, to enhance removal outcomes.

Lasers treatment for traumatic facial tattoo

Effective treatment for traumatic tattoo is lacking. We aimed to compare the effectiveness and safety between Q-1064 nm laser as monotherapy and alternating Q-1064 nm laser with CO2 AFL in treating traumatic facial tattoo (black or blue color) and accompanied scars. Clinical data of 98 patients were grouped and analyzed based on the different treatment lasers. Tattoo clearance was evaluated with a 4-point scale, and scar improvement was analyzed with modified VOSAS scores. Patient satisfaction of the tattoo clearance and scar improvement, and treatment-related complications were analyzed. Significant increased clinical effects with patient satisfaction and decreased worsened scar were confirmed with the two alternated lasers, relative to those with Q-1064 nm laser alone (P < 0.05). Consequently, alternating Q-1064 nm laser and CO2 AFL treatment could be used for traumatic facial tattoo with black or blue color removal safely and effectively.

Comparative treatments of a green tattoo ink with Ruby, Nd:YAG nano- and picosecond lasers in normal and array mode

The tattoos removal has become an issue upon spread of the tattooing practice worldwide and hindsight regrets. Lasers are typically used for the purpose, though some colours such as green are considered “recalcitrant” to the treatment. In the current investigation, we aim at determining the efficacy of removal of a green ink water dispersion, using 5 laser treatments: Nd:YAG nano- and picosecond lasers in normal and array mode and Ruby nanosecond laser, keeping the total irradiated energy constant. The UV–Vis spectroscopy of the treated samples indicate that Nd:YAG picosecond laser is most effective, and the Ruby nanosecond laser is the least efficient. Fragment compounds generated from the pigment and siloxanes are common to all treatments, whereas hydrocarbon emerge by a larger amount upon Nd:YAG nanosecond treatment. Fibres are formed upon picosecond treatments and when operating in array mode, and lamellae are achieved by Ruby nanosecond laser treatment. Residual particles suspensions are very heterogeneous upon nanosecond treatments.

Q-S laser micro-drilling and multipass full-beam Q-S laser for tattoo removal - a case series

The purpose of this study was to evaluate the safety and efficacy of a new combined method of Q-S laser-assisted tattoo removal. Ten patients with 13 professional, mostly mono-chromatic black tattoos were recruited. All tattoos received the same Q-S laser treatment sequence. An objective evaluation of tattoo clearing was assessed by careful analysis of a standardized collection of digital images taken from each tattoo, 2 months after each laser session, with the help of a custom-made pigment-fading percentage photographic ruler. The percentages of pigment clearance and side effects were evaluated by 4 independent dermatologists. Patient satisfaction and perceived discomfort during and post-procedure were evaluated according to specific scales. Clinical evaluators confirmed an average photographic pigment clearance of 97% after a median 4.85 treatment sessions. The Frac-Tat® method required 40% fewer sessions compared to those calculated by Kirby-Desai estimates. Photographic assessment of laser-exposed skin quality performed 2 months after tattoo clearing was considered almost comparable with untreated peripheral skin, confirming a very low side effect score. The Frac-Tat QS laser-assisted tattoo removal sequence used in our study showed a high degree of safety and efficiency, clearing exogenous pigments in a relatively few number of sessions. Preliminary ablative photo-acoustic fractional 1064-nm Q-S laser micro-drilling was considered an essential step in optimizing tattoo removal, increasing wavelength-independent micro-columnar clearing of deeper dermal exogenous pigments. Our preliminary observations also confirmed a significant improvement of tattoo procedure-induced micro-textural changes thanks to a tissue remodeling effect induced by the 1064-nm Q-S fractional laser photo-acoustic ablation.

The efficacy and the adverse reactions of laser-assisted tattoo removal - a prospective split study using nanosecond and picosecond lasers

BACKGROUND

Laser pulses with nanosecond duration (NSL) have been the golden standard to destroy the pigment particles in skin. It is still controversially discussed whether picosecond pulses (PSL) are superior for tattoo removal.

OBJECTIVES

To compare the efficacy and the adverse reactions of nanosecond and picosecond laser pulses in a comparative study.

METHODS

The prospective study included 23 subjects with 30 black or coloured tattoos, which were split into two halves treated with either a new PSL (532, 1064 nm) or standard NSL (694 nm). The lasers were applied at regular time intervals of 4 weeks for up to eight treatments. Tattoo clearance (primary endpoint), pain and adverse reactions (secondary endpoints) were appraised by physicians, blinded observers, and by subjects. The extent and duration of adverse reactions were additionally assessed by using a questionnaire and photo-documentation after each treatment session.

RESULTS

The tattoo clearance appeared to be more effective for PSL compared to NSL but without statistical significance (P > 0.05). Pretreated tattoos responded better to laser treatments than previously untreated tattoos. Subjects felt significantly less pain with PSL than with NSL (P < 0.001). Transient adverse reactions were statistically less pronounced lasting shorter for PSL as for NSL, especially blistering, pruritus, and burning sensation. Hypopigmentation appeared after NSL treatments only, whereas hyperpigmentation was caused by both lasers. No scarring was detected with either laser.

CONCLUSIONS

Both laser systems enable acceptable clearance of most tattoos in the present study. PSL cause less collateral skin damage as compared to NSL.